Shin Yu Seob, Pak Shang Weon, Hwang Wonku, Jo Seon Beom, Kim Jong Wook, Oh Mi Mi, Park Hong Seok, Moon Du Geon, Ahn Sun Tae
Department of Urology, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonbuk National University Medical School, Jeonju, Korea.
Department of Urology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea.
World J Mens Health. 2025 Apr;43(2):387-395. doi: 10.5534/wjmh.240023. Epub 2024 May 30.
To compare the perioperative and postoperative outcomes between traditional trans-vesical robot-assisted simple prostatectomy (TV-RASP) and the newly introduced urethral-sparing (US) RASP.
We retrospectively reviewed 42 patients who underwent TV-RASP (n=22) or US-RASP (n=20) performed by two experienced surgeons at two tertiary centers. Perioperative outcomes including operation time, estimated blood loss, length of hospital stay, and catheterization time were assessed. Postoperative outcomes were evaluated using the International Prostate Symptom Score (IPSS), quality of life (QoL), uroflowmetry parameters, Male Sexual Health Questionnaire-Ejaculation Dysfunction-Short Form (MSHQ-EjD-SF) scores, and maintenance of anterograde ejaculation.
This study analyzed 22 and 20 patients who underwent TV-RASP and US-RASP, respectively. Except for the TV-RASP group being older (70.0 years) than the US-RASP group (64.5 years) (p=0.028), no differences among other baseline characteristics existed. Perioperative outcomes indicated that hospital stay and catheterization time were significantly shorter in the US-RASP group than in the TV-RASP group (p<0.001). At postoperative month 1, the median IPSS and QoL scores were significantly better in the US-RASP group than in the TV-RASP group (p=0.001 and p=0.002, respectively). However, at months 6 and 12, no significant differences were noted in IPSS, QoL, maximum flow rate, and postvoid residual urine between the two groups. Sexually active patients in the US-RASP group maintained postoperative MSHQ-EjD functional and bother scores, whereas the TV-RASP group experienced a decline. Notably, 75.0% of patients in the US-RASP group preserved antegrade ejaculation, compared to only 20.0% in the TV-RASP group (p<0.001).
US-RASP is not inferior to TV-RASP in terms of functional outcomes. In addition, US-RASP yielded more rapid symptom improvements and preserved antegrade ejaculation than TV-RASP. However, larger prospective studies are required to confirm these findings and to further investigate the long-term efficacy and safety of US-RASP.
比较传统经膀胱机器人辅助单纯前列腺切除术（TV-RASP）与新引入的保留尿道（US）RASP的围手术期和术后结果。
我们回顾性分析了42例患者，其中22例接受了TV-RASP，20例接受了US-RASP，手术由两个三级中心的两名经验丰富的外科医生进行。评估围手术期结果，包括手术时间、估计失血量、住院时间和导尿时间。使用国际前列腺症状评分（IPSS）、生活质量（QoL）、尿流率参数、男性性健康问卷-射精功能障碍-简表（MSHQ-EjD-SF）评分以及顺行射精的维持情况来评估术后结果。
本研究分别分析了22例接受TV-RASP和20例接受US-RASP的患者。除TV-RASP组患者年龄（70.0岁）大于US-RASP组（64.5岁）（p=0.028）外，其他基线特征无差异。围手术期结果表明，US-RASP组的住院时间和导尿时间明显短于TV-RASP组（p<0.001）。术后第1个月，US-RASP组的IPSS和QoL评分中位数明显优于TV-RASP组（分别为p=0.001和p=0.002）。然而，在术后6个月和12个月时，两组在IPSS、QoL、最大尿流率和残余尿量方面无显著差异。US-RASP组有性活动的患者术后MSHQ-EjD功能和困扰评分保持不变，而TV-RASP组则有所下降。值得注意的是，US-RASP组75.0%的患者保留了顺行射精，而TV-RASP组仅为20.0%（p<0.001）。
在功能结果方面，US-RASP并不逊于TV-RASP。此外，与TV-RASP相比，US-RASP能更快改善症状并保留顺行射精。然而，需要更大规模的前瞻性研究来证实这些发现，并进一步研究US-RASP的长期疗效和安全性。
